Breast - nonmalignant
Fibrocystic disease
Radial scar

Author: Hind Nassar, M.D. (see Authors page)

Revised: 1 August 2017, last major update June 2010

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Radial scar [title] breast

Cite this page: Radial scar. PathologyOutlines.com website. http://pathologyoutlines.com/topic/breastradialscar.html. Accessed November 18th, 2017.
Definition / general
  • Benign lesion with stellate architecture, prominent fibroelastosis and epithelial hyperplasia
  • Initially described in 1977 (Am J Surg Pathol 1977;1:155)
Terminology
  • Also called complex sclerosing lesion (CSL, larger lesions), sclerosing ductal lesion, sclerosing adenosis with pseudoinfiltration, radial sclerosing lesion
  • Recommended to not use the term infiltrative epitheliosis (Semin Diagn Pathol 2010;27:5)
Epidemiology
Clinical features
Radiology description
  • Stellate abnormalities ("black star") may resemble invasive ductal carcinoma or tubular carcinoma
  • Often bilateral
Radiology images

Images hosted on PathOut server:

Mammogram, spot film, courtesy of Dr. Mark R. Wick



Images hosted on other servers:

Characteristic findings

Case reports
Treatment
Gross description
  • Stellate with central sclerosis and elastosis, resembles invasive ductal carcinoma, usually 1 cm or less
  • May be firm, irregular, with yellow streaks and flecks (due to elastotic stroma)
Gross images

Images hosted on PathOut server:

Central sclerosis and elastosis resembling carcinoma

Microscopic (histologic) description
  • "Flower head" pattern on low power
  • High power shows central fibroelastotic zone of basophilic elastic material in walls of obliterated ducts and elsewhere, with radiation of compressed tubular structures with 2 cell layers (including myoepithelium) and hyalinized stroma
  • Variable amounts of epithelial hyperplasia, adenosis and cysts
  • Perineural invasion occasionally noted
Microscopic (histologic) images

Images hosted on PathOut server:

Courtesy of Dr. Mark R. Wick

Adenosis surrounds central
area of fibrosis and elastosis
with entrapped ducts; cysts are
commonly present at periphery


Squamous metaplasia

Elastic stain highlights central elastosis

Central angular glands are
suggestive of tubular carcinoma
but peripheral duct hyperplasia
and cysts are not typical



Images hosted on other servers:

Small size, stellate shape, central fibrosis

Densely fibrotic

Ductal hyperplasia

Radiating pattern of the ducts

Central fibroelastotic core


Central fibrosis and elastosis with radiating fibrous bands and dilated ducts

Fibrosis, elastosis and ductal hyperplasia

Various images

With tubulolobular carcinoma

Cytology description
  • Fine needle aspiration often inadequate (J BUON 2002;7:137)
  • Bland epithelial clusters and bipolar naked nuclei
  • Also frequent apocrine cells, papillary clusters, foam cells and fibrillary elastoid material
  • Features are nonspecific but suggest benign diagnosis (Diagn Cytopathol 1997;17:353)
  • May also be atypical / malignant features if additional lesions present
Differential diagnosis